Vaginitis is the most common gynecological problem in adult women. Infectious vaginitis presents itself in three primary forms: (a) bacterial vaginosis, (b) candidal vaginitis or "yeast", and (c) trichomonas vaginitis or "trich." Bacterial vaginosis, which affects up to 25% of American women in the normal clinical populations, is nearly twice as common as Candida and is, in fact, the most common form of vaginal infection. Bacterial vaginosis is caused by a replacement of the normal vaginal flora with facultative anaerobic bacteria, primarily Gardnerella vaginalis. Unfortunately, the symptoms of bacterial vaginosis are non-specific or non-existent and differential diagnosis is problematic.
Complications associated with bacterial vaginosis represent a major health care cost burden. For example, obstetric complications of bacterial vaginosis include (1) preterm labor/birth, (2) low birth weight babies; (3) premature rupture of the amniotic membranes or PROM; (4) amniotic fluid infections; (5) postpartum endometritis, and (6) chorioamnionitis. Preterm/low birth weight babies is the second leading cause of infant mortality, next to birth defects. Also, bacterial vaginosis is suspected of being one of the many causes of cerebral palsy. In addition, gynecologic complications of bacterial vaginosis include (1) postoperative infections; (2) pelvic inflammatory disease (PID); (3) abnormal cervical cytology, (4) increased susceptibility to sexually transmitted diseases (STDs), and (5) posthysterectomy infections. STDs such as chlamydia, herpes, syphillis, gonorrhea, and trichomoniasis also cause potential harm to the fetus. Furthermore, a Swedish study reported in Acta Obstetricia et Gynecologica Scandinavica, 73:586-588 (1994) suggests that bacterial vaginosis may potentially be a cofactor with human papilloma virus in the development of cervical intraepithelial neoplasia (CIN), a precursor of cervical cancer.
While the rapid, accurate diagnosis of bacterial vaginosis is critical to an effective treatment decision and can minimize serious complications and costs, recent studies show that many women with bacterial vaginosis incorrectly self-diagnose their symptoms, mistaking them for yeast infections. The consensus among experts today is that proper differential diagnosis of vaginitis is essential for any OB/GYN practice, and that routine screening for bacterial vaginosis may become increasingly appropriate. Northern Europe has already implemented this approach and now conducts bacterial vaginosis tests in conjunction with annual Pap smears. Furthermore, since self-obtained vaginal swabs have been shown to be reliable specimens for use in the diagnosis of bacterial vaginosis, experts agree that home diagnostics may be the wave of the future.